Aeromedical Forum: August 2015

My father-in-law Harry was one of the greatest guys you’d ever hope to meet. He always had a ready laugh, a twinkle in his eye. He was a wonderful father to my wife and a kind and supportive grandpa to our kids. And, of course, he loved flying with us!

How heartbreaking it was to see him decline mentally as a series of strokes progressively reduced his ability to function in his last years. Unfortunately stroke or cerebrovascular accident (CVA) is a common health issue, and it’s not confined to the older population.

About 100 cases of CVA occur in every 100,000 35 to 45 year- olds each year and the incidence doubles every 10 years thereafter. A stroke occurs when the blood supply to the brain is cut off either by a blockage to an artery feeding the brain or by a hemorrhage into the brain. Either way, damage to brain tissue results, with loss of the functions which that part of the brain controls. A number of things aside from age can make you more likely to have a stroke, things that you can modify to reduce your risk.

Smoking and a sedentary life style are two biggies. Diabetes, high blood pressure and high cholesterol are other things that increase risk yet can be treated. Atrial fibrillation is a disorder of the heart where one of the upper pumping chambers stops functioning. Blood stagnates there and has a tendency to clot. These clots can break off and travel to the brain causing a CVA. This is condition with a high risk for stroke, Fortunately there are drugs that can reduce the risk of forming clots in atrial fibrillation. Unfortunately some folks just have a genetic predisposition to stroke. They will get into trouble even without increased risk factors.

If you do develop a stroke, it’s important to recognize it quickly. There are treatments that can dissolve clots that are clogging the blood vessels to your brain but they work only if administered within a few hours. The American Heart Association has a pneumonic to recognize stroke that is called FAST:

• Face drooping

• Arm weakness

• Speech Difficulty

• Time to call 911

If a stroke does occur the thrust of treatment is to minimize brain damage and then to regain function to as great a degree as possible. That’s where physical therapy plays a big roll. How much function you regain is to a large degree up to you and your ability to stick with your treatment.

Bad stuff can happen after a stroke. Depending on what centers of the brain have been affected and how much recovery has occurred, you may be an increased risk for injury from falls or seizures. Driving may be an issue. Depression is a common problem after a CVA.

So how does a pilot get back in the cockpit after a stroke? As you’d expect, you’ll have to have the FAA evaluate your condition by going through the Special Issuance process. They will ask for all of your pertinent hospital and clinic records. They will want a neurologist to go over you with a fine tooth comb to get an idea of what works and how well.

They’ll also need some x-ray and lab work to boot. They probably will want a cardiac evaluation to see how your heart is doing. Even if everything looks good, the FAA usually waits one year after the episode before giving approval to resume flying. For embolic (blood clot) strokes they frequently stretch the waiting period to two years.

They want to make sure that you are not going to have a second CVA while airborn. Also, they want to be sure you’ve reached maximum improvement following therapy.

I’m sure you’ve decided that a CVA is nothing you’d want to deal with if possible. So, if you are smoking, if you are a couch potato, do something about it! If you have high cholesterol or triglycerides, high blood pressures or diabetes, get it under control and keep it there. Work with your doc. You’ll feel a lot better now and you’ll reduce your risk of stroke (and a lot of other bad things) down the road!

Fly wisely. See you next month!

As always, comments, questions and suggestions are welcome: jdlakin@mnallergyclinic.com.